"The balance bill came in, it was 37 grand for this member, and we were able to get that thing fully wiped." - Patrick Haig

My guest this week, Patrick Haig, Co-Founder of Goodbill, has built a company designed to find errors in medical bills and fix them. From upcoding to time-based discrepancies, these inaccuracies cost health plans and their members a fortune.

In this episode, Patrick breaks down the Goodbill model. We discuss how their technology integrates directly with health plans to audit claims for errors before they're paid, and why that “upstream” approach is so game-changing. We also dive into one of their most powerful tools: the underutilized 501(r) IRS rule that can wipe out bills entirely, even for six-figure income families.

This episode is personal for me, as Patrick's team fixed my own son's ER bill, saving almost $1,000. I hope you’ll tune in!

Chapters:

(00:10:22) How DPC inspired Goodbill

(00:23:03) The 501(r) Secret: Hospital Financial Assistance

(00:27:15) How Upcoding Inflates Your ER Bill

(00:38:29) The Art of Negotiating a Hospital Bill

(00:48:43) Why "Upstream" Claim Auditing is a Game-Changer

(00:59:29) Can a Six-Figure Family Qualify for Assistance?

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02

Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286

Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/

Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"I doubled my profit when I lost 70% of my customers, which is insane." - Brad Hart

My guest this week, Brad Hart, owner of Forest Park Pharmacy, came on the show to discuss how he moved his pharmacy from struggling to survive in a broken, insurance-based reimbursement model to thriving as an all-cash, "cost-plus" business.

Brad popped on my radar because of his very popular and informative Instagram profile, where he shows how everyday Americans are getting fleeced by PBMs. We break down the mechanics of his model and discuss the "low copay trap," why the term "specialty generic" is nonsense, and how his pharmacy's Price Checker tool brings radical transparency to a purposefully confusing industry.

We also dive into the exponential overpayments Brad has uncovered in the Medicare system, where a drug that costs his pharmacy $96 is reimbursed for over $3,400.

This is one you won't want to miss!

Chapters:

(00:00:00) This Pharmacy Went Cash-Only, Lost 70% Of Customers, & Doubled Profits

(00:07:28) The "Cost-Plus" Pharmacy Model, Explained

(00:08:49) How Brad Lost 70% of Customers & Doubled Profits

(00:10:45) The Deceptive "Low Copay Trap"

(00:13:29) The Pricing Breakdown: Cost + 15% + $10

(00:34:52) Why the Term "Specialty Generic" is Nonsense

(00:47:53) What is the Average Wholesale Price (AWP)?

(00:52:41) PBM Reform vs. Direct-to-Consumer

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02

Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286

Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/

Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"Nomi actually stands for 'no middleman'. Take out that invented complexity... Price comes way down, becomes more simple to administer, and there's plenty of dollars to go around for providers now making more money." - Josh Walker

My guest this week, Josh Walker, Founder & COO of Nomi Health, is on a mission to rebuild healthcare by tackling its "invented complexity." He joined me on the show to explain why creating a direct relationship between the buyers and providers of care is the key to a better, more affordable system for everyone.

How does Nomi do it? We break down their playbook, which focuses on three core strategies: standardizing data formats to improve efficiency, embracing price discovery to find the true cost of care, and simplifying payment dynamics to cut out the middlemen.

This isn't just theory. Joshua shares the powerful, real-world results of their model, including how one client's benefits leader received a standing ovation from employees after switching to a plan that eliminated all financial barriers to care.

Tune in this week to learn why it’s so important to find the true cost of care, and why I’m so proud to have Nomi as a sponsor for the show!

Chapters:

(00:00:44) What Does NOMI Stand For?

(00:11:36) Finding the "True Cost of Care"

(00:23:27) Do We Even Need Networks Anymore?

(00:35:14) What Churros Can Teach Us About Data Analytics

(00:52:19) From Solution Taker to Solution Maker

(00:55:59) The "Standing Ovation" Health Plan

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02

Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286

Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/

Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/